Overview of Cutaneous Squamous Cell Carcinoma and Melanoma

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EP: 1.Overview of Cutaneous Squamous Cell Carcinoma and Melanoma

EP: 2.Unmet Needs and Prognosis for CSCC and Melanoma

EP: 3.Multidisciplinary Management of CSCC

EP: 4.Choosing Systemic Therapies for Patients with Unresectable or Metastatic CSCC

EP: 5.CSCC Treatment Options: Cemiplimab and Pembrolizumab

EP: 6.Treatment Duration Considerations for CSCC

EP: 7.Future Treatment Landscape for Squamous Cell Carcinoma

EP: 8.Factors that Impact Treatment Selection for Melanoma

EP: 9.BRAF/MEK Dual Inhibitors for Melanoma

EP: 10.Deciding Between Melanoma Therapy Options

EP: 11.Meaningful End Points for Patients with Metastatic Melanoma

EP: 12.Treating Patients with High-Risk Melanoma

EP: 13.Tumor-Directed Oncolytic Therapies for Melanoma and CSCC

EP: 14.Closing Thoughts on Intralesional Therapy for Melanoma and CSCC

Transcript:

Sunandana Chandra, MD, MS: Hello. Today we’ll discuss “Treatment Strategies in Advanced Cutaneous Squamous Cell Carcinoma and Melanoma.” I’m Sunandana Chandra. I’ll be the moderator for today’s session. I’m a medical oncologist at Northwestern [University] in Chicago [Illinois]. Dr Pavlick, would you like to introduce yourself?

Anna C. Pavlick, DO: Hello, my name is Anna Pavlick. I’m a medical oncologist at Weill Cornell Medical College [in New York, New York]. I’ve focused my clinical research for the past 20 years on cutaneous malignancies in melanoma.

Sunandana Chandra, MD, MS: Dr Khushalani?

Nikhil Khushalani, MD: I’m Dr Nikhil Khushalani. I’m a cutaneous medical oncologist at Moffitt Cancer Center in Tampa, Florida. I serve as a vice chair of the department and separately as the assistant center director for clinical research review and partnerships. I’m glad to be here.

Sunandana Chandra, MD, MS: Thank you both for joining us. I’ll start with a brief background on cutaneous squamous cell carcinoma, sometimes known as CSCC, as well as melanoma. Cutaneous squamous cell carcinoma is the second most common skin cancer and generally affects older adults with a median age of diagnosis of about 70 years. Although it has less propensity than melanoma to metastasize, it can result in local destruction, disfigurement due to tumor, including involvement of soft tissue, cartilage, and bone. It can spread to regional lymph nodes, and in rare instances, it can metastasize to distant organs.

Risk factors for cutaneous squamous cell carcinoma include UV [ultraviolet] exposure, including tanning bed usage; increased age; presence of skin lesions, including actinic keratosis and Bowen disease if left untreated; and chronic immunosuppression, such as those with solid organ transplant or concurrent chronic lymphocytic leukemia. Genetic syndromes, albeit rare, can also predispose people. The mainstay of therapy is local therapy that includes excision. However, when patients have unresectable or metastatic disease, that’s when they are obviously presented to medical oncology.

With respect to melanoma, there are about a 100,000 cases expected in 2023. Risk factors include UV exposure; skin type; a personal and family history of prior melanoma or specific other cancers, such as pancreatic; multiple atypical moles, or dysplastic nevi; and rarely genetic inheritable mutations. The treatment paradigm in melanoma can include excision and radiation. When it comes to systemic therapies, we often think of immunotherapy-targeted therapy, especially if they have a BRAF mutation in their tumor as well as intralesional therapy.

To begin, Drs Pavlick and Khushalani, how would you characterize the incidence of cutaneous squamous cell carcinoma as well as melanoma? How has that impacted the types of patients that you see?

Nikhil Khushalani, MD: I’ll take a stab at that. Overall, the expected incidence of melanoma this year, according to the American Cancer Society, is around 97,000. These are specifically invasive melanoma cases, with an almost an equivalent number of melanoma in situ. That incidence continues to rise, so much so that the prediction is that around the year 2040 or somewhere just beyond that, melanoma will be the most commonly diagnosed cancer in adult men in the United States.

Although that incidence continues to increase, recently there was a decrease in death rate from melanomas, likely from the significant advances that we had in advanced setting treatment, as well as regional treatment in form of adjuvant therapy. But the last 3 years have seen a slight increase in the death rate, and it’s unclear why that has occurred. Around 8000 deaths are [expected] to be attributed to melanoma in the United States in this calendar year. Did the COVID-19 pandemic play a part in that? Time will tell, as we try to understand this further.

Looking at cutaneous squamous cell carcinoma, this is a disease of the older population, and the number of older individuals in our society continues to increase. Therefore, logic stands that the number of cutaneous squamous cell cancers—as well as basal cell, which is the other keratinocytic carcinoma that we see—will continue to increase. Unfortunately, we don’t have tumor registries for either of these 2 most common types of skin cancers. A lot of our data are derived from [insurance] claims databases [measured] in terms of number of procedures done or the diagnosis codes. The estimation is that there’s 700,000 to 1 million new patients diagnosed with CSCC on an annual basis in the United States.

Transcript edited for clarity.